New University of Hull research published today warns that community nursing services nationally are struggling to keep pace with rising demand for palliative and end-of-life care.
The study found referrals to district and community nursing services increased by 50% over the past decade, while the number of people receiving care remained largely unchanged.
Over the same period, the average length of time patients spent under community nursing care fell by almost two-thirds.
Local data, drawn from Birmingham, showed palliative and end-of-life care now accounts for 9.6% of all district and community nursing clinical time, equivalent to around 30 to 32 hours of care per 1,000 population each year.
Combining national and local data
The research combined national district and community nursing data collected between 2013 and 2024 with three years of local data from Birmingham covering 2023 to 2025, funded through the National Institute for Health and Care Research’s Policy Research Unit in Palliative and End of Life Care (PRU-PEOLC), a partnership hosted by King’s College London in collaboration with the University of Hull, Lancaster University, the University of Leeds and the University of Cambridge.
Dr Sophie Pask, PRU Research Fellow at Hull York Medical School, who led the research, said: “By combining national and local data, we were able to build a detailed picture of the contribution community nurses make to palliative and end-of-life care. More people are living longer with complex long-term health conditions. The rise in demand for community-based nursing care is in line with our expectations.
“That we also found no significant increase in the number of patients receiving community based care and a significant a reduction in ‘time on caseload’ indicates a system under considerable pressure. Patients are being seen for shorter periods before discharge and then often re-referred later. Under pressure, nurses are prioritising end of life care, increasingly responding to crises, often out of hours, rather than offering planned care.”
Reducing pressure on hospitals
Professor Fliss Murtagh, Director of the Wolfson Palliative Care Research Centre at Hull York Medical School, University of Hull, said: “This study adds to a growing body of evidence showing that the way we provide end-of-life care is increasingly out of step with rising need. Our research has shown that good palliative care can improve quality of life and reduce pressure on hospitals, yet too many people still miss out on the support they need, particularly in the final months of life.
“District and community nurses are central to delivering that care, but these findings suggest they are being asked to do more with no corresponding increase in capacity. The impact of being unable to deliver the standard of care they aspire to can affect workforce wellbeing, recruitment and retention, putting further pressure on a system already under strain. If we are serious about improving access to high-quality end-of-life care and reducing inequalities, we must invest in the community workforce that makes that care possible.”
The study, Contributions to palliative and end-of-life care by community health nursing services: improving care through national and regional service evaluations (Pask et al.), is published in the Journal of Clinical Nursing.
Strong performance
The warning comes as new national data, also published today, shows Leeds’s own hospitals performing strongly on end-of-life and bereavement care. The National Audit for Care at the End of Life (NACEL) has published patient and carer data for NHS hospitals, allowing members of the public to see how their local hospital compares.
Leeds Teaching Hospitals NHS Trust said its patients have access to face-to-face specialist palliative care eight hours a day, seven days a week, compared with just 67% of hospitals nationally offering that level of access. Of relatives who gave feedback in 2025 through the annual NACEL bereavement survey, 94% at St James’s Hospital and 83% at Leeds General Infirmary rated the care they received as Excellent or Good.
The Trust said assessment of relatives’ spiritual and cultural needs remains an area for improvement nationally, and while Leeds compares favourably to national figures on this measure, it recognises there is more work to do.
Leeds Teaching Hospitals NHS Trust said it reads all feedback received from bereaved relatives and has a system in place to learn from every experience shared.
Anyone with questions or concerns about a loved one’s care can contact the Trust’s Patient Advice and Liaison Service, and anyone bereaved at one of its hospitals in 2026 is invited to complete this year’s NACEL bereavement survey.
